Psychological Treatment of Chronic Pain

1
Psychological Treatment of Chronic Pain

• Robyn Drach, Ph.D.
• Rush University Medical Center
• Rush Generations, January 24, 2007

2
Prevalence

• 1997 Michigan Pain Study surveyed 1500 adults2
• 20 of adults have ongoing chronic pain
• 10 contemplated suicide
• 25 to 50 of community dwelling older adults
  suffer from pain problems1

1 As reviewed in the Journal of American
Geriatrics Society (Clinical Practice Guidelines,
50, 2002)
2 EPIC/MRA, 1997 Executive brief "State of
Pain". Michigan pain study- A Statewide survey.
News Release, October 13, 1997
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What Is Pain?

• Its a symptom
• Its a complex process that involves biological,
  psychological, behavioral, cognitive, spiritual
  and cultural issues.
• The perception of pain can be magnified, colored,
  and reinterpreted by peoples experiences and
  expectations

4
Gate-Control Theory (Melzack Wall, 1965)

• Pain travels from the site of injury to the
  spine.
• The spine receives the message and serves as a
  gate keeper.
• The gate opens and closes to let some signals go
  through to the brain
• The brain interprets it and sends it back to the
  spine
• Thus, the amount of injury is not directly
  related to the amount of pain we may feel.

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The Gate

• Once pain makes its way to the spinal cord a
  gate determines if the message will be sent,
  changed, or go through.
• Pain is more noticeable when we're alone or
  unoccupied than when we're distracted

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The Gate

• What opens it?
• Stress
• Emotions
• Caffeine
• Nicotine
• Beliefs about pain
• Memories of past pain experiences
• Focusing on pain

• What closes it?
• Exercise
• Relaxation
• Positive attitude
• Healthy Diet
• Proper Sleep
• Distraction

Spinal Cord
Pain
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What happens in Chronic Pain?

• Regeneration of the nerve that has been injured
• Inflammation (arthritis)
• Sensitization

8
Acute Pain

• Acute Pain
• Identifiable source, new damage or injury
• Time-limited (Doctor cures)
• Improves with rest and time
• Short term use of medication

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Chronic Pain

• Chronic Pain
• Unrelieved pain. The symptom itself becomes the
  disease
• Activity is necessary for recovery
• Causes depression and anxiety
• Gets worse with rest and fluctuates over time

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Mind-Body Connection

• Can clearly be demonstrated with the experience
  of stress
• Fight, Flight or Freeze reaction
• Autonomic Nervous System
• SNS-arousal
• PNS-return to normal state relaxation response

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Treatment

• Cognitive-Behavioral Therapy

Feelings and Thoughts
Behaviors
Physical Sensations
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Cognitive Barriers

• Irrational beliefs/cognitive distortions
• All or Nothing Thinking
• Over-Generalization
• Negative Filtering
• Disqualifying the positive
• Jumping to conclusions
• Focusing on the pain
• Emotions depression, anxiety

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Cognitive Solutions

• Increase self-efficacy and hopefulness/assertivene
  ss
• Reframing
• Problem solving/goal setting
• Divert attention
• Mindfulness
• Imagery
• Alter self-defeating thoughts

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Behavioral Barriers

• Sitting on the couch all day
• Spending lots of time alone with nothing to do
• Taking long naps that disrupt sleep
• Spending less time doing activities that you
  enjoy
• Letting others help you with tasks that you are
  able to do
• Doing tasks that will exacerbate your pain
• Pushing yourself too hard

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Behavioral Solutions

• Pacing activities
• Increase pleasurable activities
• Diaphragmatic Breathing Exercises
• Progressive Muscle Relaxation
• Passive Muscle Relaxation
• Autogenic Relaxation

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Conclusion

• Chronic pain affects many older adults
• Pain is complex and is affected by how you think,
  feel, and your behaviors
• You can have some control over your pain
  experience

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Thank you